BENGALURU: Every day, hundreds wait for cadaveric organs from patients declared brain dead. While one would want everyone to get a second chance with a donor organ, doctors on sub-committees for various organ transplants — kidney, heart and liver — have to take a call in a few hours as to who gets the organ among potential recipients.
Though there is an established rotation system for all the 15 transplant centres in the state, in emergency situations, the call is made by the sub-committees that are constituted annually.
Dr N S Nagesh, head of the liver transplant unit at Pradhan Mantri Swasthya Suraksha Yojana Super-specialty Hospital, is on the liver sub-committee of Jeevasarthakathe, the state organ transplant authority. There are 946 patients waiting for a liver. Liver transplants are complex in relative comparison to other organs because the liver has to be cut down to a particular size and shape.
Dr Nagesh said, “We don’t have a point system like in kidney transplant waiting list that determines the urgency. In emergency situations, we give priority to acute liver failure patients or those that require dual organs like liver and kidney. Otherwise, it is based on seniority in each blood group. We also calculate graft versus recipient weight ratio. Paediatric donations can go only to paediatric recipients. Once in two months, we get into special situations where we have to take a call based on clinical parameters.”
Since dialysis option is available for kidney, they have a point system on how urgent a particular case is. There are 2,342 patients waiting for a kidney. There are three nephrologists on the kidney sub-committee.
Dr Anil Kumar B T, senior consultant nephrologist and transplant physician, BGS Global Hospital, one of the sub-committee members, said, “Our challenges include making these decisions in the middle of the night. Currently, since there are zones like Hubballi, Mangaluru and Mysuru, for organ allocation, it is more streamlined. In the kidney sub-committee, we assess the health of the donor organ. The allocation is solely based on seniority, one organ goes to the hospital where it is harvested and the other goes to the general pool.”
At least a dozen times a month, the doctors make a conference call with other members of the committee to arrive at a consensus, once Jeevasarthakathe sends them the donor and potential recipient reports.
Dr Nagamalesh U M, senior consultant, cardiology, heart failure and transplant, Ramaiah Narayana Heart Centre, said, “Once in a week, three of our doctors on the sub-committee take a call on emergency situations. If there is a difference in opinion, at least two of us should agree on who should get the heart.” There are 59 patients waiting for a heart.